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|CBC
*Hemoglobin level is between 5-9 g/dl
*Hematocrit is decreased to 17-29%
*Leukocytosis with predominance of neutrophils
*Thrombocytopenia
ESR
*Decreased
Reticulocyte count
*Elevated
Peripheral blood smear
*May demonstrate target cells, elongated cells, and sickle erythrocytes
*Howell - Jolly bodies in an asplenic patient
Hemoglobin solubility
*Distinguishes between sickle cell disease and sickle cell trait
Hemoglobin F
*Percentage of Hemoglobin F is elevated 
LFT, renal function test and pulmonary function test
*To assess organ distress or failure
ABG
*To detect oxygen saturation
Urine analysis
*May determine an urinary tract infection with hematuria and isosthenuria
Sickling test
*As screening for sickle hemoglobinopathies
Secretory phospholipase A2
*May be increased in acute chest syndrome, a complication of sickle cell disease
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Revision as of 20:00, 1 April 2018

Back pain Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]


An expert algorithm to assist in the diagnosis of back pain can be found here

Overview

There are several life-threatening causes of back pain which need to be evaluated for first, which include; spinal cord or cauda equina compression, aortic dissection, aortic aneurysm, vertebral osteomyelitis, epidural abscess, and metastatic cancer. The other possible causes of back pain can be evaluated for by carefully assessing the nature of the pain, and obtaining a thorough patient history.

Differential Diagnosis

Life Threatening Causes

Life threatening diseases to exclude immediately include:[1][2][3][4][2][3][5][6][7][8][9][10][11][12][13][14][15][16][17]

Common Causes


Differential Diagnosis of Back Pain

The following table outlines the major differential diagnoses of back pain.

Abbreviations: ABG = Arterial blood gases, ANA = Antinuclear antibodies, BUN = Blood urea nitrogen, CRP = C-reactive protein, CT = Computed Tomography, DRA = Dual energy radiographic absorptiometry, DRE = Digital rectal exam, ERCP = Endoscopic retrograde cholangiopancreatography, ESR = Erythrocyte sedimentation rate, HSV = Herpes simplez virus, IVP = Intravenous pyelography, KUB = Kidney, bladder, ureter, LDH = Lactate dehydrogenase, LFT = Liver function test, MRC = Magnetic resonance cholangiopancreatography, MRI = Magnetic resonance imaging, NSAIDs = Non-steroidal anti-inflammatory drugs, PCR = Polymerase chain reaction, PET - FDG = Positive emission tomography - fluorodeoxyglucose, PET = Positive emission tomography, PID = Pelvic inflammatory disease, PSA = Prostatic specific antigen, PTC = Percutaneous transhepatic cholangiography, RUQ = Right upper quadrant, SPECT = Single-photon emission computed tomography, TFT = Thyroid function test, VZV = Varicella Zoster virus




Classification of pain in the back based on etiology Diease Clinical Manifestation Diagnosis Comments
Symptoms Signs Lab findings Imaging
Onset Duration Quality of pain Radiation Stiffness Fever Rigors and chills Headache Nausea and vomiting Syncopy Weight loss Motor weakness Sensory deficit Pulse Deficit Heart Murmur Bowel or bladder dysfunction Horner's syndrome
Vascular Retroperitoneal hematoma[18][19][20] Acute or subacute Minutes to hours Sharp and knife-like, also tearing or ripping Back and/or flanks - - - - +/- - - - - - - - -

Typically no specific lab findings, however, evidence of haemorrhage and organ injury may be seen in:

  • Complete blood count; normochromic normocytic anemia seen in haemorrhage
  • Elevated serum electrolytes
  • Elevated liver function tests
  • Elevated amylase or lipase
CT with IV contrast
  • May show venous delay and indicate renal trauma

Cystography

  • Should be considered in evaluation of hematuria and pelvic injury
  • Mostly caused by automobile accidents
Classification of pain in the back based on etiology Diease Clinical Manifestation Diagnosis Comments
Symptoms Signs Lab findings Imaging
Onset Duration Quality of pain Radiation Stiffness Fever Rigors and chills Headache Nausea and vomiting Syncopy Weight loss Motor weakness Sensory deficit Pulse Deficit Heart Murmur Bowel or bladder dysfunction Horner's syndrome
Neurological Arachnoiditis[21] Acute Hours Dull aching pain Head, neck and back +/- + +/- +/- +/- +/- +/- +/- +/- - - +/- +/- CSF
  • Elevated protein with normal or low glucose

Culture and sensitivity

  • May be due to TB or Meningitis

Nucleic acid tests

  • Helpful in tuberculous meningitis
Radiography
  • Thickened nerve roots

CT

  • Narrowing of subarachnoid space
  • Irregular collections of contrast material
  • Thickened nerve roots

MRI

  • Study of choice shows indistinct cord outline
  • Usually caused by meningitis or TB
Cauda equina syndrome[22][23] Acute Hours Severe, sharp local pain Rarely to sacroiliac joint - - - - - - - + +/- - - +/- - CBC
  • To rule out anemia

Electrolytes, blood urea nitrogen, and creatinine

  • To rule out renal failure and retroperitoneal hematoma

Erythrocyte sedimentation rate

  • To rule out inflammatory origin

Syphilis serology

  • To rule out meningovascular syphilis
Radiography
  • May show vertebral erosions

MRI

  • Of choice and may show nerve root abnormalities

Duplex

  • For vascular abnormalities

Lumbar puncture

  • For inflammation
Electrical studies:

EMG

  • Done to rule out acute denervation

SSEPs

  • Done to rule out multiple sclerosis
Epidural abscess[24][25] Acute Variable Dull, throbbing pain Locally - +/- +/- +/- +/- +/- +/- +/- +/- - - +/- +/- CBC
  • May show leukocytosis, left shift, thrombocytopenia, and anemia

ESR

  • Elevated

Culture and sensitivity

  • To identify causative organism

Immunohistochemical staining

  • Includes gram stain, special stains for fungi and mycobacteria, also consider brucella
MRI
  • Of choice and demonstrates fluid collection

CT

  • Demonstrates fluid collection

Radiography

  • Demonstrates osteomyelitis or vertebral collapse
  • LP carries risk of spread of infection
Radiculopathy[26][27] Acute Variable Severe, shooting pain Anterior thigh and knee +/- - - - - - - +/- +/- - - +/- -
  • Typically no specific lab findings

Radiography

  • To rule out serious underlying etiology

CT

  • Demonstrates disc herniation

MRI

  • Demonstrates disc herniation and nerve root impingement

Myelography

  • Used preoperatively to visualize spinal anatomy accurately

Discography

  • To localize a symptomatic disc
  • Disc herniation is the most common cause of nerve impingement
Sciatica[28][29][29] Acute Minutes to hours Severe, shooting pain Posterior thigh, buttocks and knee +/- - - - - - - +/- +/- - - +/- - To exclude other pathologies
  • CBC with differential
  • ESR
  • Alkaline and acid phosphatase level
  • Serum calcium level
  • Serum protein electrophoresis

Radiography

  • With technetium-99m labeled phosphorus to indicate bone mineralization status

CT

  • Demonstrates disc herniation

MRI

  • Demonstrates disc herniation and nerve root impingement

Myelography

  • Used preoperatively to visualize spinal anatomy accurately

Discography

  • To localize a symptomatic disc
  • May have a psychological component
Spinal cord compression[22][23]

- Thoracic spine

- Lumbar spine

Acute Minutes to hours Severe and localized Locally, may radiate below lesion - - - - - - - +/- +/- - -

+/-

- Neoplasm must be suspected and is ruled out by
    • CBC - May demonstrate a pancytopenia
    • Prothrombin time and activated partial thromboplastin time - May be prolonged
    • Metabolic profile, including calcium level and liver function - May indicate metastasis
MRI
  • May demonstrate tumors and collapse of intervertebral spaces
  • May distinguish between bone lesions and malignancy

Radiography

  • May demonstrates bony destruction or calcification

Nuclear imaging

  • To identify neoplasms
  • Aggressive radiotherapy is often needed
Classification of pain in the back based on etiology Diease Clinical Manifestation Diagnosis Comments
Symptoms Signs Lab findings Imaging
Onset Duration Quality of pain Radiation Stiffness Fever Rigors and chills Headache Nausea and vomiting Syncopy Weight loss Motor weakness Sensory deficit Pulse Deficit Heart Murmur Bowel or bladder dysfunction Horner's syndrome
Bone Ankylosing spondylitis[30][31] Subacute or chronic Years Dull aching pain Local + - - - - - - - - - - - -
  • Typically no specific lab findings
MRI
  • Demonstrates both inflammatory and structural lesions

CT

  • Useful in identifying structural lesions

Radiography

  • Useful in identifying structural lesions

Doppler ultrasound

  • To detect active esthesitis

Extra-articular manifestations are common and include

  • Uveitis
  • CVD
  • Respiratorydisease
  • Renal disease
  • Neurologic disease
  • GI disease
  • Metabolic bone disease

Often affecting a young male

Bertolotti's syndrome[22] (Lumbosacral transitional vertebrae) Chronic Years Dull aching pain Local - - - - - - - - - - - - -
  • Typically no specific lab findings

MRI

  • Of choice and demonstrates transitional vertebra

CT

  • Demonstrates vertebral transition

Radiography

  • Demonstrates vertebral transition
  • Congenital anomaly and may be asymptomatic
Chronic recurrent focal osteomyelitis[32][33][34] Chronic Years Dull aching pain Local +/- + + - - - +/- - - - - - - CBC
  • Leukocytosis and left shift

ESR

  • Elevated

CRP

  • Elevated

Procalcitonin

  • Elevated

Culture and sensitivity

  • To identify causative agent
Radiography
  • Demonstrates endosteal or medullary lesion
  • Sequestration and cavity formation

MRI

  • Bone marrow abnormalities and lytic changes

CT

  • Articular and periarticular involvement

Ultrasound

  • Soft tissue abnormalities

Nuclear imaging

  • Loss of bone density
  • Acute presentation is often seen in children and is associated with gait abnormalities
Cervical fracture[35][36] Acute Minutes to hours Severe, sharp Shoulder and arm - - - +/- - - - +/- +/- - - - +/-
  • Typically no specific lab findings
Radiography
  • May demonstrate fracture of the vertebrae and/or preexisting pathology that may have lead to fracture

CT

  • May show pathology that was not noted on radiography

MRI

  • May show pathology that was not noted on radiography
  • If suspected should be stablized immediately
Degenerative disc disease[37][38] Subacute or chronic Years Dull aching Local +/- - - - - - - +/- +/- - - +/- +/- Serology
  • HLA-B27 may be positive or negative
  • IgA may be elevated
  • ANA may be positive
  • Rheumatoid factor may be positive

CBC

  • May indicate anemia

ESR

  • May be elevated

CRP

  • May be elevated

Uric acid

  • May be elevated
MRI
  • Demonstrates delineation and position of vertebrae

CT

  • Demonstrates delineation and position of vertebrae
  • May also visualize nerve root compression and nerve swelling

Diskography

  • Controversial, demonstrates disc herniation
  • Transforaminal selective nerve root blocks are used diagnostically and therapeutically in cases presenting with radicular pain
Disc herniation[39][40] Acute Minutes to hours Sharp,shooting Legs and hips - - - - - - - +/- +/- - - +/- -
  • Typically no specific lab findings
MRI
  • Demonstrates the size and location of the herniated disc and surrounding soft tissue

CT myelography

  • Useful in lateral herniations with calcification

Radiography

  • Demonstrates osteophytes, disc-space narrowing, and kyphosis

Discography

  • Controversial, may show endplate irregularites or annular tears
  • Often presents with parathesias and no pain
Discitis[41][42] Chronic Years Dull aching or throbbing Local - + +/- - +/- - +/- +/- +/- - - +/- - CBC
  • May demonstrate leukocytosis

ESR

  • May be elevated

CRP

  • May be elevated

Procalcitonin

  • May be elevated

Culture and sensitivity

  • To identify causative agent
MRI
  • Narrowing of disk space and low signalling indicates edema

CT

  • Detects lesions earlier than radiography, demonstrates hypodensity of disk and destruction of endplates and calcification of annulus

Radiography

  • Disk space narrowing with destruction of endplates and calcification of annulus

Nuclear imaging

  • Focal uptake of gallium-67 and technetium-99m in area of destruction
  • Most likely due to hematogenous spread of organism
Hyperkyphosis[43][44] Chronic Years Dull aching Local +/- - - - - - - +/- +/- - - - -
  • Typically no specific lab findings, however; CBC may be done to rule out other serious pathologies.
Radiography
  • Wedge-shaped vertebrae
  • Narrow intervertebral disk spaces with calcifications
  • Prominent irregularities of vertebrae
  • Arcuate kyphosis
  • Often begins as loss of height with normal aging
Osteoarthritis[45][46][47] Chronic Years Dull aching Local + - - - - - - - - - - - - ESR
  • Elevated

CRP

  • Elevated

Synovial fluid analysis

  • WBCs < 2000/mm3
  • Polys < 25%
  • Culture negative
  • Crystal negative
  • Elevated IL-2, IL-5, MCP-1
Radiography
  • Asymmetric joint space narrowing
  • Subchondral sclerosis
  • Subchondral cysts

MRI

  • Joint space narrowing
  • Degeneration
  • Gradual onset
  • Polyarthritis
  • Hips, knees, distal and proximal interphalyngeal joints and spine involvement
  • Bouchard's and Heberden's nodes
Sacroiliac joint dysfunction[48][49] Chronic Years Dull aching Hips and legs +/- - - - - - - +/- +/- - - +/- - CBC
  • May show leukocytosis

ESR

  • May be elevated

CRP

  • May be elevated

Serology

  • ANA
  • Rheumatoid factor
  • HLA-B27

Metabolic panel

  • May indicate hypothyroidism or cortisol abnormalities
Imaging is controversial, however, CT may demonstrate;
  • Reactive spurs
  • Sclerosis
  • Subluxation

MRI

  • Used primarily to exclude disc herniation

Nuclear imaging

  • Used to rule out stress fractures and metastatic bone disease
  • Rehabilitation is often sought
Sacroilitis[49][50] Acute or chronic Variable Dull aching or throbbing Hips and legs +/- + +/- - - - +/- +/- +/- - - +/- - CBC
  • May demonstrate leukocytosis

ESR

  • May be elevated

CRP

  • May be elevated

Procalcitonin

  • May be elevated

Culture and sensitivity

  • To identify causative agent
MRI
  • Narrowing of joint space and low signalling indicates edema

CT

  • Detects lesions earlier than radiography, demonstrates hypodensity of joint space and destruction of articular surface

Radiography

  • Joint space narrowing with destruction of joint space

Nuclear imaging

  • Focal uptake of gallium-67 and technetium-99m in area of destruction
  • Most likely due to hematogenous spread of organism
Scheuermann (juvenile) kyphosis[51][52] Chronic Years Dull aching Shoulders and arms +/- - - - - - - - - - - - -
  • Typically no specific lab findings
Radiography
  • Wedge-shaped vertebra
  • Arcuate kyphosis
  • Narrow intervertebral discs with calcifications
  • Prominent irregularities of the vertebrae
  • Vertebral plates are underdeveloped and demonstrate multiple herniations of the nucleus pulposus (Schmorl nodes)
  • Schmorl nodes are also seen in Wilson's disease and are not specific
Scoliosis[53][54][55] Chronic Years Dull aching Shoulders, arms, hips and legs +/- - - - - - - +/- +/- - - +/- -
  • Typically no specific lab findings
Radiography
  • Bending of the thoracic curve is noted

MRI

  • Used to assess additional complaints such as headaches, not routine for adolescents
  • Most commonly is idiopathic
Spinal stenosis[56][57] Chronic Years Dull aching Hips and legs +/- - - - - - - +/- +/- - - +/- +/-
  • Typically no specific lab findings
MRI
  • Demonstrates narrowing of central canal, lateral recess, and neuronal foramina

CT

  • Demonstrates narrowing of central canal, lateral recess, and neuronal foramina
  • Premature imaging is strongly not recommended and may harm patient
  • Normal aging process
Spondylosis[58][59] Chronic[60] Years Dull aching Shoulders, arms, hips and legs +/- - - +/- - - - +/- +/- - - +/- +/-
  • Typically no specific lab findings
Radiography
  • Demonstrates osteophytes and disc-space narrowing

MRI

  • Demonstrates the location of destruction and surrounding soft tissue

CT myelography

  • Demonstrates osteophytes and calcified opacities
  • Progresses with aging
Vertebral compression fracture[61][62][63] Acute Minutes to hours Sudden, severe, sharp Shoulders, arms, hips and legs +/- - - +/- +/- +/- - +/- +/- - - +/- - CBC
  • Decreased hematocrit and anemia

PSA

  • To rule out prostatic cancer

Urine analysis

  • To detect Bence - Jones protein

Serum protein electrophoresis

  • M spike is seen with multiple myeloma

ESR

  • May be elevated
Radiography
  • Decreased vertebral body height

CT

  • Detects more subtle fractures and calcifications

MRI

  • Useful in those with motor weakness and sensory deficits
  • May demonstrate hemorrhage, tumor, or infection

DRA scanning

  • Detects low bone density

PET scanning

  • To distinguish benign from malignant causes of compression
  • Presents as a midline back pain
Vertebral osteomyelitis[64][65][66] Acute Minutes to hours Sudden, severe, sharp Shoulders, arms, hips and legs +/- + +/- - +/- - - +/- +/- - - +/- - CBC
  • Leukocytosis and left shift

ESR

  • Elevated

CRP

  • Elevated

Procalcitonin

  • Elevated

Culture and sensitivity

  • To identify causative agent
Radiography
  • Demonstrates endosteal or medullary lesion
  • Sequestration and cavity formation

MRI

  • Bone marrow abnormalities and lytic changes

CT

  • Articular and periarticular involvement

Ultrasound

  • Soft tissue abnormalities

Nuclear imaging

  • Loss of bone density
  • Often caused by hematogenous spread of organism
Classification of pain in the back based on etiology Diease Clinical Manifestation Diagnosis Comments
Symptoms Signs Lab findings Imaging
Onset Duration Quality of pain Radiation Stiffness Fever Rigors and chills Headache Nausea and vomiting Syncopy Weight loss Motor weakness Sensory deficit Pulse Deficit Heart Murmur Bowel or bladder dysfunction Horner's syndrome
Referred pain Aortic aneurysm

rupture[67][68][69] - Abdominal aortic aneurysm

- Thoracic aortic aneurysm

Acute Minutes to hours Sharp and knife-like, also tearing or ripping Back and/ or flanks - - - - - +/- - - - + +/- - - Typically no specific lab findings, however, evidence of haemorrhage and organ injury may be seen in:
  • Complete blood count; normochromic normocytic anemia seen in haemorrhage
  • Elevated serum electrolytes
  • Elevated liver function tests
  • Elevated amylase or lipase
Ultrasonography
  • Visualization of aneurysm, size and/or rupture and hematoma

Chest radiography

  • Visualizes calcifications in aneurysm but not specific

CT

  • Demonstrates aortic size, extent, and involvement of organ arteries

MRI

  • Has advantage of less radiation and no use for dye, whilst demonstrating same findings as ultrasound and CT

Angiography

  • Allows 3D construction of aorta

Echocardiography (Transesophageal)

  • Demonstrates fluid shift and need for cardiology intervention
  • Livedo reticularis may be seen and indicates thrombotic phenomenon
Aortic dissection[70][71][72][72][73][74] Severe and sudden (acute) and rarely, chronic Minutes to hours Sharp and knife-like, also tearing or ripping Back and/or flanks - - - - - +/- - - - + +/- - - Elevations in:
  • D - dimer
  • Smooth muscle myosin heavy chain
  • Soluble ST2
  • Soluble elastin fragments
  • High -sensitivity C-reactive protein
  • Fibrinogen
  • Fibrillin fragments
ECG:
  • Normal
  • Non - specific ST wave changes
  • Hypertrophy patterns
  • ST segment elevation indicating myocardial infarction

Chest radiography:

  • Normal
  • Mediastinal or aortic widening
  • Increased risk of occurence with Marfan syndrome
Appendicitis[75][76][77] Acute Minutes to hours Burning Umbilicus and lower right quadrant - + +/- - + - - - - - - - - CBC
  • Demonstrates leukocytosis and neutrophilia

CRP

  • May be elevated

Urine analysis

  • May demonstrate pyuria, hematuria, and/or proteinuria

Urine 5-HIAA

  • Maybe an early marker of appendictis
  • Sudden increase may indicate necrosis
Ultrasound
  • Demonstrates a non-compressible tubular structure

CT

  • Demonstrates an enlarged appendix with thickened walls and can detect abnormally located appendices

MRI

  • Useful in pregnant ladies

KUB Radiography

  • May detect an appendicolith

Barium enema

  • Demonstrates absent or incomplete filling
  • Cecal spasm may be present

Radionuclide scanning

  • Appendiceal inflammation may be present
  • Pain begins around the umbilicus and then shifts to RUQ
Cholelithiasis[78][79] Acute or subacute Minutes or hours Sharp Tip of right shoulder - +/- +/- - + - +/- - - - - - - CBC
  • Demonstrates polymorphnuclear leukocytosis

LFT

  • Elevated alanine aminotransferase and aspartate aminotransferases
  • Elevated conjugated bilirubin

Amylase and lipase

  • Elevated
Radiography
  • Radio-opaque stones may be present

CT

  • May indicate presence of gallstones in the distal common bile duct

MRI

    • May indicate presence of gallstones in the distal common bile duct

Ultrasound

  • May demonstrate gallbladder wall thickening (>5 mm) and gallbladder fluid and distention
  • Gallstones may appear as echogenic foci that cast an acoustic shadow

Scintigraphy

  • May detect cystic duct obstruction

ERCP

  • Stones are seen as a filling defect and can be removed simultaneously

PTC

  • Similar to ERCP
  • Used when ERCP is not feasible
  • May be completely asymptomatic
Chronic stable angina[80][81] Chronic Variable Discomfort in the chest Left shoulder, arm and jaw - - - - +/- +/- - - - +/- +/- - - Detection of:
  • Urinary proton nuclear magnetic resonance spectroscopy
  • Toll-like receptors 2 and 4 (TLR-2 and TLR-4)  on platelets
Chest radiography
  • Normal, may show calcification or complications such as pleural effusion

Exercise stress testing

  • Establishes diagnosis and extent of angina

Stress Echo

  • To evaluate wall motion, normal in stable angina

Nuclear imaging

  • To assess myocardial perfusion, reduced in stable angina

CT

  • To evaluate coronary artery calcium (cac) which may or may not be elevated

CT Angiography

  • To evaluate stenosis, <70% in stable angina

EKG

  • Normal in stable angina
  • Hallmark is relief by rest or sublingual nitroglycerin
Cystitis[82][83][84] Acute Hours Burning Suprapubic - +/- +/- - - - - - - - - - - Urine analysis
  • May demonstrate pyuria, hematuria, white blood cell casts and proteinuria

Urine culture

  • Detection of > 1000 colony-forming units/ml

CBC

  • May demonstrate leukocytosis and/or anemia
  • Typically no routine imaging done
  • Cystitis may be infectious, hemorrhagic, radiational, or sterile
Endocarditis[85][86][87] Acute or subacute Variable Discomfort in the chest Jaw and arms - +/- +/- - +/- +/- - - - +/- + - - CBC
  • Anemia and leukocytosis may be noted

Serology

  • Decrease C3, C4, and CH50 may indicate subacute endocarditis
  • Rheumatoid factor may be positive

ESR

  • May be elevated

Urine analysis

  • May demonstrate proteinuria and microscopic hematuria

Blood culture

  • To identify causative agent
  • Streptococci and HACEK organisms are culture negative
  • Organisms that grow on prosthetic valves tend to be coagulase-negative staphylococci
Echocardiography
  • Vegetations and myocardial abscesses may be present

Radiography

  • Pyogenic emboli may be seen across the lung field

Ultrasound

  • Myocardial abscesses may be seen
  • Valvular dysfunction may also be noted
  • IV drug users and those who suffer from rheumatic heart disease often present with infective endocarditis
Myalgia[88][89][90] Chronic Years Dull aching Variable +/- +/- +/- +/- - - - - - - - - - *Typically no specific lab findings
  • A full workup should be done to exclude other etiologies, such as;

Rheumatoid factor and/or anti-cyclic citrullinated peptide antibodies

  • May indicate cause is rheumatoid arthritis

CRP and ESR

  • May be elevated

CBC

  • May indicate anemia

Bone profile

  • May be caused by a vitamin D or calcium deficiencyDipstick urinalysis
  • Typically no routine imaging done
  • May be associated with Hepatitis C and Lyme disease
Nephrolithiasis[91][92][93] Acute Hours Severe, sharp Abdomen, hips, groin, legs - +/- +/- - +/- - - - - - - - - CBC
  • Mild leukocytosis may indicate infection

Electrolytes

  • Hypokalemia may indicate acute tubular necrosis
  • Hypercalcemia or hypercalciuria may be detected

Creatinine

  • To identify potential renal injury with contrast

Uric acid

  • Uric acid stones sometimes occur with gout

ABG

  • May indicate acute tubular necrosis with hypokalemia and decreased bicarbonate
CT
  • Visualizes calcium stones and other possible pathologies, such as hydronephrosis

IVP

  • Visualizes stones and entire urinary system

KUB radiography

  • Radio-opaque stones may be present

Ultrasound

  • For visualization of stones

Plain renal tomography

  • Can distinguish between intrarenal and extrarenal calcifications

Retrograde pyelography

  • Particularly useful for ureteral calculi visualization

Nuclear renal imaging

  • May determine a decreased renal function
  • Hypercalcemia may indicate primary or secondary hyperparathyroidism
Pancreatitis[94][95][96] Acute or chronic Variable Severe, sharp or dull aching Abdomen - +/- +/- - + +/- +/- - - - - - - Amylase and lipase
  • Elevated

LFT

  • Elevated alkaline phosphatase, total bilirubin, aspartate aminotransferase, and alanine aminotransferase

CBC

  • May demonstrate leukocytosis

Serum electrolytes

  • May indicate hypo or hypercalcemia

BUN and creatinine

  • May be elevated

Triglycerides

  • Usually elevated, however, falsely lowered during acute attack
KUB radiography
  • May demonstrate free air within abdomen, indicating a perforated viscus

Ultrasound

  • Used to visualize the pancreas and biliary tree
  • May detect microlithiasis and periampullary lesions

CT

  • Pancreas may appear enlarged

MRC

  • May demonstrate a blockage within the biliary ducts

ERCP

  • May remove a blockage, however, can in fact cause pancreatitis
  • Usually caused by binge drinking or long standing gallstones that block the ampulla of Vater
  • Vomiting is a common manifestation
Pelvic inflammatory disease[97][98][99] Acute or chronic Variable Dullaching or throbbing Hips, groin, legs - +/- +/- - +/- - - - - - - - - CBC
  • Leukocytosis, may indicate infection with trichomoniasis

Pregnancy test

  • To rule out ectopic pregnancy

STD panel

  • To rule out gonorrhea, chlamydia, hepatitis B and C, HIV, and syphilis

Urine analysis

  • To rule out a urinary tract infection
Transvaginal ultrasound
  • May demonstrate anechoic structures in adnexa indicating hydrosalpinx and/or pyosalpinx

Laparoscopy

  • May demonstrate adhesions (Asherman's syndrome) or gun powder lesions (Endometriosis) or an ectopic pregnancy

MRI and CT

  • May indicate hydro and/ or pyosalpinx
  • Inflammation may spread to perihepatic structures (Fitz-Hugh−Curtis syndrome)
Pulmonary embolism[100][101][102] Acute Minutes Severe, sharp Chest and back +/- - - +/- +/- +/- - - - +/- +/- - - Lab findings are not specfic and are done to rule out other diseases such as:
    • Antithrombin III deficiency
    • Protein C or protein S deficiency
    • Lupus
    • Homocystinuria
    • Malignancy
    • Connective tissue disorders
  • D - dimer is positive and ventilation- perfusion scanning will show a a perfusion/ventilation mismatch
  • CT Angiography and duplex angiography are able to visualize the embolism
  • PE may occur even in patients that are fully anticoagulated
  • DVT is a common source
Pyelonephritis[103] Acute or chronic Variable Severe, sharp or dull aching Groin, hips and legs - + +/- - +/- - - - - - - - - CRP
  • Elevated

ESR

  • Elevated

Urinalysis

  • Pyuria
  • Bacteriuria
  • May be nitrite positive (gram negative organisms)
  • Culture positibe (Uncomplicated: E. coli, Proteus mirabialis, Klebsiella, S. saprophyticus- Complicated: E. coli, enterococci, S.epidermidis
Ultrasound
  • Hydronephrosis

Non-contrast CT

  • Pelvicalceal dilation
  • Cortical involvement

MRI

  • T1: affected region(s) appear hypointense compared with the normal kidney parenchyma
  • T2: hyperintense compared to normal kidney parenchyma
  • T1 C+: reduced enhancement
  • Renal stones
  • Obstruction
  • Pregnancy
  • Prolonged urinary catheterization
Pneumonia[104][105][106] Acute or chronic Variable Variable Chest, back and abdomen - + + +/- +/- +/- +/- - - - - - - CBC
  • Leukocytosis is often demonstrated however, white blood cell count may be normal

Blood culture

  • To identify causative organism or rule out other organisms such as MRSA
Radiography
  • Plain x-ray shows multiple patches in the lung fields

CT

  • Used to distinguish pneumonia from non-pneumonias
  • Hospital-acquired pneumonia is common
Pyomyositis[107][108][109][110] Acute or chronic Days to weeks Dull aching or throbbing Variable - + +/- - - - - - - - - - - CBC
  • Demonstrates leukocytosis

ESR

  • Elevated

Serum creatine kinase and aldolase

  • Normal

Blood culture

  • Typically negative

Culture and sensitivity

  • May include a positive gram stain
MRI
  • Can differentiate between osteomyelitis and pyomyositis by demonstrating early muscle inflammation or abscess formation

CT

  • May demonstrate hypertrophy of muscles and/or effacement of fatty plane
  • An enhancement in contrast may indicate abscess formation

Ultrasound

  • Useful in determining specific muscle involvement

Gallium scan

  • Useful in detecting early muscle pathology
  • Infectious myositis was once considered a tropical disease, however with the emergence of HIV is now prevalent in western societies too
Rheumatoid arthritis[111][112][113] Chronic Years Severe, aching Variable + - - - - - +/- - - - - - - ESR and CRP
  • Elevated

CBC

  • May indicate anemia

Rheumatoid factor

  • May be positive

ANA

  • May be positive

Anti−cyclic citrullinated peptide (anti-CCP) and anti−mutated citrullinated vimentin (anti-MCV)

  • Are specific to rhuematoid arthritis
Radiography
  • Osteopenia is noted
  • Metacarpal bone erosion
  • Narrow joint space without osteophytes

MRI

  • Pannus formation may be noted

Ultrasound

  • Effusion of joint may be seen
  • Symmetric polyarthritis
  • Morning stiffness with improvement throughout the day
  • Deformities of the hand are common
Traumatic aortic rupture[114][115] Acute Minutes to hours Sharp and knife-like, also tearing or ripping Back and/ or flanks - - - - - +/- - - - +/- +/- - - Typically no specific lab findings, however, evidence of haemorrhage and organ injury may be seen in:
  • Complete blood count; normochromic normocytic anemia seen in haemorrhage
  • Elevated serum electrolytes
  • Elevated liver function tests
  • Elevated amylase or lipase
Ultrasonography
  • Visualization of rupture, size and hematoma

CT

  • Demonstrates intimal flap, hematoma, filling defect, aortic contour abnormality, pseudoaneurysm, vessel wall disruption, and extravasation of intravenous contrast

MRI

  • Has advantage of less radiation and no use for dye, whilst demonstrating same findings as ultrasound and CT

Angiography

  • Allows 3D construction of aorta

Echocardiography (Transesophageal)

  • Demonstrates fluid shift and need for cardiology intervention
  • Mostly caused by automobile accidents
Waterhouse-Friderichsen syndrome[116][117] Acute Minutes to hours Sudden, severe, sharp Back and/or flanks - + +/- +/- +/- +/- +/- - - - - - - CBC
  • May show decreased hemotocrit, leukocytosis and rarely, eosinophilia

Serum electrolytes

  • Hyponatremia
  • Hyperkalemia
  • Hypercalcemia

Blood urea nitrogen

  • Elevated

Creatinine

  • Elevated

Plasma glucose 

  • Hypoglycemia

Serum cortisol

  • Decreased

Plasma ACTH,

  • Elevated
CT
  • Shows adrenal enlargement or adrenal aymmetry
  • Short cosyntropin (Cortrosyn) stimulation test confirms the diagnosis
Classification of pain in the back based on etiology Diease Clinical Manifestation Diagnosis Comments
Symptoms Signs Lab findings Imaging
Onset Duration Quality of pain Radiation Stiffness Fever Rigors and chills Headache Nausea and vomiting Syncopy Weight loss Motor weakness Sensory deficit Pulse Deficit Heart Murmur Bowel or bladder dysfunction Horner's syndrome
Tumors Ewing's sarcoma[118][119][120] Chronic Months to years Dull aching Variable +/- +/- +/- - - - + - - - - - -

Tests are used to rule out other pathologies; CBC

  • May indicate anemia

Blood cultures

  • May be positive for various organisms

ESR and CRP

  • May be elvated

LDH

  • May be elevated

Cytogenetic studies

  • May be positive for t(11;22) translocation

Immunohistochemical markers

  • May be positive for MIC2 antigen (CD99)
Radiography
  • Periosteal reaction "onion skin"
  • Cortical thinning
  • Mottling

MRI

  • Skip lesions
  • Edema
  • Metastasis

PET - FDG

  • To identify metastatic disease
Langerhans cell histiocytosis[121][122][123][123](eosinophilic granulomas) Chronic Months to years Dull aching Variable - +/- +/- - - - - - - - - - - Tests used to rule out other pathologies;

CBC

  • Reticulocyte count may be increased
  • Positive or negative direct and indirect Coombs test
  • Immunoglobulin levels may be elevated

ESR

  • May be elevated

LFT

  • May demonstrate elevations in total protein, albumin, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and gamma-glutamyltransferase
  • Elevations may mean liver cirrhosis

Urine analysis

  • Decrease in urine osmolality may indicate diabetes insipidus
Radiography
  • Single or multiple osteolytic lesions may be noted

CT

  • To identify abnormalities of the hypothalamic and/or pituitary region

MRI

  • To identify abnormalities of the hypothalamic and/or pituitary region

PET - FDG

  • More sensitive than CT or MRI to active disease
Leukemia[124][125][126][127] Acute or chronic Weeks to years Aching Variable - +/- +/- - - - + - - - - - - CBC
  • Mature or immature leukocytosis

Coagulation study

  • May demonstrate elevated prothrombin time, decreasing fibrinogen level, and presence of fibrin split products

Peripheral blood smear

  • May demonstrate blasts, schistocytes, auer rods, and mature lymphocytosis

Blood chemistry profile

  • May demonstrate tumor lysis syndrome through elevated LDH and uric acid

Blood culture

  • To rule out infection
  • Typically no routine imaging studies, cytogenetic and flow cytometries aid diagnosis
  • Acute and chronic, lymphocytic and myeloid diagnoses are based on the presence and type of blast or mature cell
Lymphoma[128][129][130][131] Chronic Months to years Aching Variable - +/- +/- - - - + - - - - - - Typically no specific lab findings, however, the following routine tests are performed;
  • CBC
  • Serum chemistry studies, including LDH
  • Serum beta2-microglobulin level
  • HIV serology
Radiography
  • May demonstrate hilar or mediastinal adenopathy
  • Pleural or pericardial effusion
  • Parenchymal involvement
  • Bulky mediastinal mass

CT

  • May demonstrate enlarged lymph nodes
  • Hepatosplenomegaly
  • Filling defects in visceral organs

Bone scan

  • Useful in those with elevated alkaline phosphatase

Gallium scan

  • May show increased uptake

MRI

  • Signal intensity changes are noted in those with bone marrow or muscular involvement

PET - FDG

  • To distinguish between viable, active tumors and necrosis
  • To detect early recurrence

Ultrasound

  • Useful if primary lesion is in testis
  • Hodgkin's lymphoma is usually focal and characterized by Reed-sternberg cells
  • Non - hodgkin's lymphoma tends to be multifocal
  • Biopsy provides ultimate diagnosis
Neurofibroma[132] Chronic[133][134] Weeks to years Aching, pressure Variable - - - - - - - - - - - - - Molecular sequencing
  • Used to detect neurofibromin gene

Urine analysis

  • Used to detect free catecholamine and their metabolites in suspected pheochromocytoma
Radiography
  • Bowing of bones
  • Medullary destruction

MRI and CT

  • Used to determine neurologic pathologies
  • May demonstrate unidentified bright objects in brain scans
  • May demonstrate optic nerve and optic chiasma involvement
  • Bilateral acoustic neuroma is noted in neurofibromatosis type 2

PET - FDG

  • Used to determine staging
  • Marfanoid habitus may be noted in neurfibromatosis type 1
Osteoblastoma[135][136][137] Chronic Weeks to years Dul aching Variable - - - - - - - - - - - - -
  • Typically no specific lab findings are noted
Radiography
  • May demonstrate a well-circumscribed radiolucent tumor in cortex
  • Thin shell of peripheral new bone distinct from soft tissue
  • > 2cm in diameter
  • No associated reactive zone

CT and MRI

  • May demonstrate size and extent of tumor relative to surrounding soft tissue

Bone scan

  • Demonstrates cortical activity within the bone

Angiography

  • Demonstrates the vascularity of the tumor
  • Presents in third decade of life
  • Pain is not relieved by NSAIDs
Osteoid osteoma[138][139][135] Chronic Years Dull aching Variable - - - - - - - - - - - - - Serum chemistry study
  • High levels of prostaglandin metaboliteshave been linked with osteoid osteomas
Radiography
  • May demonstrate sclerosis around a radiolucent nidus

CT

  • Demonstrates the margins of the nidus and calcifications present

MRI

  • Useful only in a non-calcified nidus

Radionuclide scan

  • Demonstrates increased uptake in diseased bone

Arteriography

  • Used a last resort when other imaging has been unfruitful
  • Demonstrates 2 phases, early arterial phase, late arterial phase and venous phase
  • Pain is relieved by use of NSAIDs
Osteosarcoma[140][141][142][143] Chronic Weeks to years Severe, sharp Variable - - - - - - - - - - - - -
  • Typically no specific lab findings
  • Elevated LDH and alkaline phosphatase may suggest pulmonary metastasis

Radiography

  • May demonstrate an osteolytic or osteoblastic lesion
  • Elevation of the periosteum may be noted, and is known as "Codman's triangle"
  • Tumor spread to periosteum is known as "sunburst" sign

CT

  • Chest CT is done to rule out pulmonary involvement
  • May also demonstrate the margins and extent of tumor

MRI

  • Useful in detection of soft tissue involvement

Bone scan

  • Increased uptake is noted in regions of metastasis
  • Technetium-99 - methylene diphosphonate is usually used
  • Cardiac function should be assessed before the use of doxorubicin or daunorubicin
Multiple myeloma[144][145] Chronic Years Dull aching Hips, groin and legs +/- +/- +/- - - - +/- - - - - +/- - Serum protein electrophoresis
  • May demonstrate a M peak

Serum free light chain assay and 24 - hour urine collection

  • May detect Bence-Jones proteins

CRP

  • May be elevated

Serum beta2-microglobulin

  • May be elevated

Albumin

  • May demonstrate elevated albumin in urine

LDH

  • May be elevated

Peripheral blood smear

  • May demonstrate rouleaux formation > 50%
  • Leukopenia
  • Thrombocytopenia
Radiography, MRI and PET
  • Osteolytic lesions may be demonstrated
  • Biopsy will demonstrate elevated plasma cells in the bone marrow
Prostate cancer[146][147] Chronic Months to years Severe, sharp Lower abdomen, hips, groin and legs - +/- +/- - - - +/- - - - - - - PSA
  • Detection is helpful in diagnosis, usually > 10 ng/ml

Acid and alkaline phosphtase

  • Useful in detecting metasstasis

Serurm creatinine and LFT

  • Useful in detecting metasstasis

Urine analysis

  • May detect hematuria or infection
Ultrasound
  • Transrectal biopsy transrectal ultrasound may demonstrate hypoechoicity

MRI

  • May be used to guide biopsy
PSA and DRE are gold standard for screening
Classification of pain in the back based on etiology Diease Clinical Manifestation Diagnosis Comments
Symptoms Signs Lab findings Imaging
Onset Duration Quality of pain Radiation Stiffness Fever Rigors and chills Headache Nausea and vomiting Syncopy Weight loss Motor weakness Sensory deficit Pulse Deficit Heart Murmur Bowel or bladder dysfunction Horner's syndrome
Muscle-related Abnormal posturing[148][149][150][151] Chronic Years Dull aching Shoulders, arms, hips, legs +/- - - - - - - - - - - - -
  • Typically no specific lab findings
  • Typically no routine imaging done, diagnosed clinically
  • Back brace maybe used with gentle exercise
Muscle spasm[152][153] Acute Days, weeks, months Aching Variable - - - - - - - - - - - - -
  • Typically no specific lab findings

MRI and ultrasound

  • May be utilized in non-resolution of muscle spasm to visualize the soft tissue
  • Rest, bandaging and topical analgesics are often used to treat
Pyriformis syndrome[154][155] Chronic Years Aching Hips and legs +/- - - - - - - - - - - - -
  • Typically no specific lab findings

MRI and ultrasound

  • May be utilized in non-resolution of muscle spasm to visualize the soft tissue
  • Rest, bandaging and topical analgesics are often used to treat
Classification of pain in the back based on etiology Diease Clinical Manifestation Diagnosis Comments
Symptoms Signs Lab findings Imaging
Onset Duration Quality of pain Radiation Stiffness Fever Rigors and chills Headache Nausea and vomiting Syncopy Weight loss Motor weakness Sensory deficit Pulse Deficit Heart Murmur Bowel or bladder dysfunction Horner's syndrome
Miscellaneous Chronic fatigue syndrome[156][157][158] Chronic Years Dull aching Variable +/- - - +/- +/- - - - - - - - -
  • Typically no specific lab findings, however, serology may be somewhat specific and demonstrate;
    • Elevated IgM and/or IgG in coxsackievirus B titer
    • Elevated IgM and/or IgG human herpesvirus 6 titer
    • Elevated IgM/IgG in C pneumoniae titer
    • Decrease in natural killer cell percentage or activity
  • Labs used to exclude other pathologies include;

CBC

  • May demonstrate leukopenia or leukocytosis

LFT

  • May demonstrate elevated serum transaminases, alkaline phosphatase, or lactic dehydrogenase

TFT

  • To rule out hypo/hyperthyroidism

ESR

  • Usually low

Serum electrolytes

  • Hypokalemia or hypocalcemia may be noted

ANA

  • May indicate an autoimmune disease

Cortisol

  • May indicate pathology of the adrenal gland

Serum protein electrophoresis

  • To rule out myeloma or lymphoma
CT and MRI
  • Used to exclude other pathologies

PET

  • May demonstrate hypoperfusion of the frontoparietal and/or temporal region of the brain
Usually diagnosed by exclusion
Depression[159][160][160] Chronic Months to years Severe to mild aching Variable +/- - - +/- +/- +/- +/- - - - - - -
  • Typically no specific lab findings
  • Lab testing is used to diagnose organic causes and include;
    • CBC
    • TFT
    • Vitamin B-12 detection
    • Rapid plasma reagin
    • HIV testing
    • Electrolytes, especially calcium, phosphate, and magnesium levels
    • BUN and creatinine
    • LFTs
    • Blood alcohol level
    • Blood and urine toxicology screen
    • ABG
    • Dexamethasone suppression test
    • Cosyntropin stimulation test
CT and MRI
  • To rule out organic brain syndrome or hyporpituitarism

PET

  • Allows for study of ligand-receptor binding

SPECT

  • May demonstrate regional blood flow deficits in the left anterofrontal and temporal regions
  • Must assess suicidal ideation
Dysmenorrhea[161][162] Acute 3 - 7 days Burning, dull aching or severe Groin, hips, legs - - - +/- +/- - - - - - - - -
  • Typically no specific lab findings
  • Lab tests are done to rule out organic causes, and include;
    • CBC
      • Infection (leukocytosis) or malignancy
    • STD panel
      • Gonorrhea, chlamydia, and PID
    • Beta - Human chorionic gonadotropin
      • Elevated in pregnancy
    • ESR
    • Elevated in subacute salpingitis
    • Urine analysis
    • To rule out urinary tract infection
    • Stool guaiac test
      • To rule out gastraintestinal bleeding
Ultrasound
  • May reveal endometriosis as complex mass with specks
  • Ectopic pregnancy
  • Ovarian cysts
  • Fibroids
  • Intrauterine contraceptive device

Hysterosalpingography

  • May demonstrate endometrial polyps
  • Leiomyomas
  • Congenital abnormalities of the uterus

IVP

  • May demonstrate a uterine malformation

CT

  • May demonstrate ovarian torsion

MRI

  • May detect adenomyosis
  • Submucous myomas
  • Laparoscopy, hysteroscopy, and dilatation and curettage are useful in diagnosis and therapy
Herpes zoster[163][164][165] Acute or chronic Variable Severe, stabbing, electric-like Dermatomal - +/- +/- +/- +/- +/- +/- - +/- - - - - Tzanck smear
  • May demonstrate multinucleated giant cells

Direct fluorescent antibody test and/or PCR

  • Allows for differentiation between HSV and VZV
  • Typically no routine imaging

MRI

  • Used to exclude myelopathy or encephalopathy

Lumbar puncture and cerebrospinal fluid analysis

  • In cases of suspected meningitis, increased protein and pleocytosis will be noted
Pregnancy[166][167][168][169][170] Chronic Pregnancy term Dull aching Groin, hips, legs +/- - - - - - - - - - - - - Beta - human chorionic gonadotropin
  • If detected usually confirms pregnancy
  • Typically no routine imaging is done to prevent radiation exposure, unless complication occurs an MRI may be carried out
Sickle cell anemia[171][172][173] Acute or chronic Variable Severe, sharp Variable +/- + +/- - - - - - - - - - - CBC
  • Hemoglobin level is between 5-9 g/dl
  • Hematocrit is decreased to 17-29%
  • Leukocytosis with predominance of neutrophils
  • Thrombocytopenia

ESR

  • Decreased

Reticulocyte count

  • Elevated

Peripheral blood smear

  • May demonstrate target cells, elongated cells, and sickle erythrocytes
  • Howell - Jolly bodies in an asplenic patient

Hemoglobin solubility

  • Distinguishes between sickle cell disease and sickle cell trait

Hemoglobin F

  • Percentage of Hemoglobin F is elevated

LFT, renal function test and pulmonary function test

  • To assess organ distress or failure

ABG

  • To detect oxygen saturation

Urine analysis

  • May determine an urinary tract infection with hematuria and isosthenuria

Sickling test

  • As screening for sickle hemoglobinopathies

Secretory phospholipase A2

  • May be increased in acute chest syndrome, a complication of sickle cell disease
Syringomyelia[174][175][176] Chronic Years Dull aching Variable +/- +/- - +/- +/- - - - - - - - -
Trauma[177] Acute or chronic Variable Severe, sharp to dull aching Variable +/- - - - +/- +/- - +/- +/- - - +/- +/-
Ureteropelvic junction obstruction[178][179][180] Acute Hours to days Dull aching Groin, hips, legs - +/- +/- +/- +/- - - - - - - +/- -

References

  1. Chou R, Qaseem A, Owens DK, Shekelle P (February 2011). "Diagnostic imaging for low back pain: advice for high-value health care from the American College of Physicians". Ann. Intern. Med. 154 (3): 181–9. doi:10.7326/0003-4819-154-3-201102010-00008. PMID 21282698.
  2. 2.0 2.1 Schiff D, O'Neill BP, Suman VJ (August 1997). "Spinal epidural metastasis as the initial manifestation of malignancy: clinical features and diagnostic approach". Neurology. 49 (2): 452–6. PMID 9270576.
  3. 3.0 3.1 Deyo RA, Diehl AK (1988). "Cancer as a cause of back pain: frequency, clinical presentation, and diagnostic strategies". J Gen Intern Med. 3 (3): 230–8. PMID 2967893.
  4. Sun JC, Xu T, Chen KF, Qian W, Liu K, Shi JG, Yuan W, Jia LS (April 2014). "Assessment of cauda equina syndrome progression pattern to improve diagnosis". Spine. 39 (7): 596–602. doi:10.1097/BRS.0000000000000079. PMID 24150427.
  5. Jarvik JG, Deyo RA (October 2002). "Diagnostic evaluation of low back pain with emphasis on imaging". Ann. Intern. Med. 137 (7): 586–97. PMID 12353946.
  6. Underwood MR, Dawes P (November 1995). "Inflammatory back pain in primary care". Br. J. Rheumatol. 34 (11): 1074–7. PMID 8542211.
  7. "Acute low back problems in adults: assessment and treatment. Agency for Health Care Policy and Research". Clin Pract Guidel Quick Ref Guide Clin (14): iii–iv, 1–25. December 1994. PMID 7987418.
  8. Ropper AH, Zafonte RD (March 2015). "Sciatica". N. Engl. J. Med. 372 (13): 1240–8. doi:10.1056/NEJMra1410151. PMID 25806916.
  9. Delitto A, Piva SR, Moore CG, Fritz JM, Wisniewski SR, Josbeno DA, Fye M, Welch WC (April 2015). "Surgery versus nonsurgical treatment of lumbar spinal stenosis: a randomized trial". Ann. Intern. Med. 162 (7): 465–73. doi:10.7326/M14-1420. PMID 25844995.
  10. Papadopoulos EC, Khan SN (January 2004). "Piriformis syndrome and low back pain: a new classification and review of the literature". Orthop. Clin. North Am. 35 (1): 65–71. doi:10.1016/S0030-5898(03)00105-6. PMID 15062719.
  11. Hopayian K, Song F, Riera R, Sambandan S (December 2010). "The clinical features of the piriformis syndrome: a systematic review". Eur Spine J. 19 (12): 2095–109. doi:10.1007/s00586-010-1504-9. PMC 2997212. PMID 20596735.
  12. Potter NA, Rothstein JM (November 1985). "Intertester reliability for selected clinical tests of the sacroiliac joint". Phys Ther. 65 (11): 1671–5. PMID 2932746.
  13. Russel AS, Maksymowych W, LeClercq S (December 1981). "Clinical examination of the sacroiliac joints: a prospective study". Arthritis Rheum. 24 (12): 1575–7. PMID 7326071.
  14. Levangie PK (November 1999). "Four clinical tests of sacroiliac joint dysfunction: the association of test results with innominate torsion among patients with and without low back pain". Phys Ther. 79 (11): 1043–57. PMID 10534797.
  15. Riddle DL, Freburger JK (August 2002). "Evaluation of the presence of sacroiliac joint region dysfunction using a combination of tests: a multicenter intertester reliability study". Phys Ther. 82 (8): 772–81. PMID 12147007.
  16. Irwin RW, Watson T, Minick RP, Ambrosius WT (January 2007). "Age, body mass index, and gender differences in sacroiliac joint pathology". Am J Phys Med Rehabil. 86 (1): 37–44. PMID 17304687.
  17. Jancuska JM, Spivak JM, Bendo JA (2015). "A Review of Symptomatic Lumbosacral Transitional Vertebrae: Bertolotti's Syndrome". Int J Spine Surg. 9: 42. doi:10.14444/2042. PMC 4603258. PMID 26484005.
  18. Poplin GS, McMurry TL, Forman JL, Hartka T, Park G, Shaw G, Shin J, Kim H, Crandall J (May 2015). "Nature and etiology of hollow-organ abdominal injuries in frontal crashes". Accid Anal Prev. 78: 51–7. doi:10.1016/j.aap.2015.02.015. PMID 25744173. Vancouver style error: initials (help)
  19. Kuan JK, Wright JL, Nathens AB, Rivara FP, Wessells H (February 2006). "American Association for the Surgery of Trauma Organ Injury Scale for kidney injuries predicts nephrectomy, dialysis, and death in patients with blunt injury and nephrectomy for penetrating injuries". J Trauma. 60 (2): 351–6. doi:10.1097/01.ta.0000202509.32188.72. PMID 16508495.
  20. Harris DG, Drucker CB, Brenner ML, Sarkar R, Narayan M, Crawford RS (November 2013). "Patterns and management of blunt abdominal aortic injury". Ann Vasc Surg. 27 (8): 1074–80. doi:10.1016/j.avsg.2012.09.019. PMID 23790766.
  21. Ozateş M, Kemaloglu S, Gürkan F, Ozkan U, Hoşoglu S, Simşek MM (January 2000). "CT of the brain in tuberculous meningitis. A review of 289 patients". Acta Radiol. 41 (1): 13–7. PMID 10665863.
  22. 22.0 22.1 22.2 Bach F, Larsen BH, Rohde K, Børgesen SE, Gjerris F, Bøge-Rasmussen T, Agerlin N, Rasmusson B, Stjernholm P, Sørensen PS (1990). "Metastatic spinal cord compression. Occurrence, symptoms, clinical presentations and prognosis in 398 patients with spinal cord compression". Acta Neurochir (Wien). 107 (1–2): 37–43. PMID 2096606.
  23. 23.0 23.1 Helweg-Larsen S, Sørensen PS (1994). "Symptoms and signs in metastatic spinal cord compression: a study of progression from first symptom until diagnosis in 153 patients". Eur. J. Cancer. 30A (3): 396–8. PMID 8204366.
  24. Nathoo N, Nadvi SS, van Dellen JR (April 1999). "Cranial extradural empyema in the era of computed tomography: a review of 82 cases". Neurosurgery. 44 (4): 748–53, discussion 753–4. PMID 10201299.
  25. Heran NS, Steinbok P, Cochrane DD (October 2003). "Conservative neurosurgical management of intracranial epidural abscesses in children". Neurosurgery. 53 (4): 893–7, discussion 897–8. PMID 14519222.
  26. Bischoff RJ, Rodriguez RP, Gupta K, Righi A, Dalton JE, Whitecloud TS (August 1993). "A comparison of computed tomography-myelography, magnetic resonance imaging, and myelography in the diagnosis of herniated nucleus pulposus and spinal stenosis". J Spinal Disord. 6 (4): 289–95. PMID 8219542.
  27. Tarulli AW, Raynor EM (May 2007). "Lumbosacral radiculopathy". Neurol Clin. 25 (2): 387–405. doi:10.1016/j.ncl.2007.01.008.
  28. Hay MC (June 1976). "Anatomy of the lumbar spine". Med. J. Aust. 1 (23): 874–6. PMID 967084.
  29. 29.0 29.1 Vroomen PC, de Krom MC, Wilmink JT, Kester AD, Knottnerus JA (February 1999). "Lack of effectiveness of bed rest for sciatica". N. Engl. J. Med. 340 (6): 418–23. doi:10.1056/NEJM199902113400602. PMID 9971865.
  30. Roussou E, Sultana S (January 2011). "Spondyloarthritis in women: differences in disease onset, clinical presentation, and Bath Ankylosing Spondylitis Disease Activity and Functional indices (BASDAI and BASFI) between men and women with spondyloarthritides". Clin. Rheumatol. 30 (1): 121–7. doi:10.1007/s10067-010-1581-5. PMID 20882310.
  31. Deodhar A, Strand V, Kay J, Braun J (May 2016). "The term 'non-radiographic axial spondyloarthritis' is much more important to classify than to diagnose patients with axial spondyloarthritis". Ann. Rheum. Dis. 75 (5): 791–4. doi:10.1136/annrheumdis-2015-208852. PMID 26768406.
  32. Lew DP, Waldvogel FA (2004). "Osteomyelitis". Lancet. 364 (9431): 369–79. doi:10.1016/S0140-6736(04)16727-5. PMID 15276398.
  33. Mader JT, Shirtliff M, Calhoun JH (December 1997). "Staging and staging application in osteomyelitis". Clin. Infect. Dis. 25 (6): 1303–9. PMID 9431368.
  34. Lew DP, Waldvogel FA (April 1997). "Osteomyelitis". N. Engl. J. Med. 336 (14): 999–1007. doi:10.1056/NEJM199704033361406. PMID 9077380.
  35. Nelson DW, Martin MJ, Martin ND, Beekley A (July 2013). "Evaluation of the risk of noncontiguous fractures of the spine in blunt trauma". J Trauma Acute Care Surg. 75 (1): 135–9. PMID 23940857.
  36. Greenbaum J, Walters N, Levy PD (January 2009). "An evidenced-based approach to radiographic assessment of cervical spine injuries in the emergency department". J Emerg Med. 36 (1): 64–71. doi:10.1016/j.jemermed.2008.01.014. PMID 18783909.
  37. Deyo RA, Tsui-Wu YJ (April 1987). "Descriptive epidemiology of low-back pain and its related medical care in the United States". Spine. 12 (3): 264–8. PMID 2954221.
  38. Slipman CW, Sterenfeld EB, Chou LH, Herzog R, Vresilovic E (March 1998). "The predictive value of provocative sacroiliac joint stress maneuvers in the diagnosis of sacroiliac joint syndrome". Arch Phys Med Rehabil. 79 (3): 288–92. PMID 9523780.
  39. Hay MC (June 1976). "Anatomy of the lumbar spine". Med. J. Aust. 1 (23): 874–6. PMID 967084.
  40. Levin KH (May 2002). "Electrodiagnostic approach to the patient with suspected radiculopathy". Neurol Clin. 20 (2): 397–421, vi. PMID 12152441.
  41. Hamanishi C, Tanaka S (October 1993). "Dorsal root ganglia in the lumbosacral region observed from the axial views of MRI". Spine. 18 (13): 1753–6. PMID 8235857.
  42. Gupta A, Kowalski TJ, Osmon DR, Enzler M, Steckelberg JM, Huddleston PM, Nassr A, Mandrekar JM, Berbari EF (December 2014). "Long-term outcome of pyogenic vertebral osteomyelitis: a cohort study of 260 patients". Open Forum Infect Dis. 1 (3): ofu107. doi:10.1093/ofid/ofu107. PMC 4324221. PMID 25734175.
  43. Milne JS, Lauder IJ (July 1974). "Age effects in kyphosis and lordosis in adults". Ann. Hum. Biol. 1 (3): 327–37. PMID 4419577.
  44. Schneider DL, von Mühlen D, Barrett-Connor E, Sartoris DJ (April 2004). "Kyphosis does not equal vertebral fractures: the Rancho Bernardo study". J. Rheumatol. 31 (4): 747–52. PMID 15088302.
  45. Hawker GA, Stewart L, French MR, Cibere J, Jordan JM, March L, Suarez-Almazor M, Gooberman-Hill R (April 2008). "Understanding the pain experience in hip and knee osteoarthritis--an OARSI/OMERACT initiative". Osteoarthr. Cartil. 16 (4): 415–22. doi:10.1016/j.joca.2007.12.017. PMID 18296075.
  46. Hurley MV, Scott DL, Rees J, Newham DJ (November 1997). "Sensorimotor changes and functional performance in patients with knee osteoarthritis". Ann. Rheum. Dis. 56 (11): 641–8. PMC 1752287. PMID 9462165.
  47. Sale JE, Gignac M, Hawker G (February 2008). "The relationship between disease symptoms, life events, coping and treatment, and depression among older adults with osteoarthritis". J. Rheumatol. 35 (2): 335–42. PMID 18203312.
  48. Betti L, von Cramon-Taubadel N, Manica A, Lycett SJ (2013). "Global geometric morphometric analyses of the human pelvis reveal substantial neutral population history effects, even across sexes". PLoS ONE. 8 (2): e55909. doi:10.1371/journal.pone.0055909. PMC 3567032. PMID 23409086.
  49. 49.0 49.1 Foley BS, Buschbacher RM (December 2006). "Sacroiliac joint pain: anatomy, biomechanics, diagnosis, and treatment". Am J Phys Med Rehabil. 85 (12): 997–1006. doi:10.1097/01.phm.0000247633.68694.c1. PMID 17117004.
  50. Carette S, Graham D, Little H, Rubenstein J, Rosen P (February 1983). "The natural disease course of ankylosing spondylitis". Arthritis Rheum. 26 (2): 186–90. PMID 6600615.
  51. Lowe TG (July 1999). "Scheuermann's disease". Orthop. Clin. North Am. 30 (3): 475–87, ix. PMID 10393769.
  52. Codd PJ, Riesenburger RI, Klimo P, Slotkin JR, Smith ER (December 2006). "Vertebra plana due to an aneurysmal bone cyst of the lumbar spine. Case report and review of the literature". J. Neurosurg. 105 (6 Suppl): 490–5. doi:10.3171/ped.2006.105.6.490. PMID 17184084.
  53. Stirling AJ, Howel D, Millner PA, Sadiq S, Sharples D, Dickson RA (September 1996). "Late-onset idiopathic scoliosis in children six to fourteen years old. A cross-sectional prevalence study". J Bone Joint Surg Am. 78 (9): 1330–6. PMID 8816647.
  54. McAlister WH, Shackelford GD (April 1975). "Classification of spinal curvatures". Radiol. Clin. North Am. 13 (1): 93–112. PMID 1129452.
  55. Riseborough EJ, Wynne-Davies R (July 1973). "A genetic survey of idiopathic scoliosis in Boston, Massachusetts". J Bone Joint Surg Am. 55 (5): 974–82. PMID 4760104.
  56. Katz JN, Harris MB (February 2008). "Clinical practice. Lumbar spinal stenosis". N. Engl. J. Med. 358 (8): 818–25. doi:10.1056/NEJMcp0708097. PMID 18287604.
  57. Ciol MA, Deyo RA, Howell E, Kreif S (March 1996). "An assessment of surgery for spinal stenosis: time trends, geographic variations, complications, and reoperations". J Am Geriatr Soc. 44 (3): 285–90. PMID 8600197.
  58. Yabuki S, Kikuchi S (July 1996). "Positions of dorsal root ganglia in the cervical spine. An anatomic and clinical study". Spine. 21 (13): 1513–7. PMID 8817777.
  59. Lestini WF, Wiesel SW (February 1989). "The pathogenesis of cervical spondylosis". Clin. Orthop. Relat. Res. (239): 69–93. PMID 2536306.
  60. Storm PB, Chou D, Tamargo RJ (August 2002). "Surgical management of cervical and lumbosacral radiculopathies: indications and outcomes". Phys Med Rehabil Clin N Am. 13 (3): 735–59. PMID 12380556.
  61. Genant HK, Cooper C, Poor G, Reid I, Ehrlich G, Kanis J, Nordin BE, Barrett-Connor E, Black D, Bonjour JP, Dawson-Hughes B, Delmas PD, Dequeker J, Ragi Eis S, Gennari C, Johnell O, Johnston CC, Lau EM, Liberman UA, Lindsay R, Martin TJ, Masri B, Mautalen CA, Meunier PJ, Khaltaev N (1999). "Interim report and recommendations of the World Health Organization Task-Force for Osteoporosis". Osteoporos Int. 10 (4): 259–64. PMID 10692972.
  62. Vogt TM, Ross PD, Palermo L, Musliner T, Genant HK, Black D, Thompson DE (September 2000). "Vertebral fracture prevalence among women screened for the Fracture Intervention Trial and a simple clinical tool to screen for undiagnosed vertebral fractures. Fracture Intervention Trial Research Group". Mayo Clin. Proc. 75 (9): 888–96. PMID 10994823.
  63. Papaioannou A, Watts NB, Kendler DL, Yuen CK, Adachi JD, Ferko N (August 2002). "Diagnosis and management of vertebral fractures in elderly adults". Am. J. Med. 113 (3): 220–8. PMID 12208381.
  64. Beronius M, Bergman B, Andersson R (2001). "Vertebral osteomyelitis in Göteborg, Sweden: a retrospective study of patients during 1990-95". Scand. J. Infect. Dis. 33 (7): 527–32. PMID 11515764.
  65. Digby JM, Kersley JB (February 1979). "Pyogenic non-tuberculous spinal infection: an analysis of thirty cases". J Bone Joint Surg Br. 61 (1): 47–55. PMID 370121.
  66. McHenry MC, Rehm SJ, Krajewski LP, Duchesneau PM, Levin HS, Steinmuller DR (1991). "Vertebral osteomyelitis and aortic lesions: case report and review". Rev. Infect. Dis. 13 (6): 1184–94. PMID 1775852.
  67. Chaikof EL, Brewster DC, Dalman RL, Makaroun MS, Illig KA, Sicard GA, Timaran CH, Upchurch GR, Veith FJ (October 2009). "The care of patients with an abdominal aortic aneurysm: the Society for Vascular Surgery practice guidelines". J. Vasc. Surg. 50 (4 Suppl): S2–49. doi:10.1016/j.jvs.2009.07.002. PMID 19786250.
  68. Sullivan CA, Rohrer MJ, Cutler BS (June 1990). "Clinical management of the symptomatic but unruptured abdominal aortic aneurysm". J. Vasc. Surg. 11 (6): 799–803. PMID 2359191.
  69. Lesperance K, Andersen C, Singh N, Starnes B, Martin MJ (June 2008). "Expanding use of emergency endovascular repair for ruptured abdominal aortic aneurysms: disparities in outcomes from a nationwide perspective". J. Vasc. Surg. 47 (6): 1165–70, discussion 1170–1. doi:10.1016/j.jvs.2008.01.055. PMID 18394857.
  70. Suzuki T, Distante A, Eagle K (November 2010). "Biomarker-assisted diagnosis of acute aortic dissection: how far we have come and what to expect". Curr. Opin. Cardiol. 25 (6): 541–5. doi:10.1097/HCO.0b013e32833e6e13. PMID 20717014.
  71. Wang Y, Tan X, Gao H, Yuan H, Hu R, Jia L, Zhu J, Sun L, Zhang H, Huang L, Zhao D, Gao P, Du J (January 2018). "Magnitude of Soluble ST2 as a Novel Biomarker for Acute Aortic Dissection". Circulation. 137 (3): 259–269. doi:10.1161/CIRCULATIONAHA.117.030469. PMID 29146682.
  72. 72.0 72.1 Akutsu K, Yamanaka H, Katayama M, Yamamoto T, Takayama M, Osaka M, Sato N, Shimizu W (November 2016). "Usefulness of Measuring the Serum Elastin Fragment Level in the Diagnosis of an Acute Aortic Dissection". Am. J. Cardiol. 118 (9): 1405–1409. doi:10.1016/j.amjcard.2016.07.052. PMID 27666178.
  73. Suzuki T, Katoh H, Tsuchio Y, Hasegawa A, Kurabayashi M, Ohira A, Hiramori K, Sakomura Y, Kasanuki H, Hori S, Aikawa N, Abe S, Tei C, Nakagawa Y, Nobuyoshi M, Misu K, Sumiyoshi T, Nagai R (October 2000). "Diagnostic implications of elevated levels of smooth-muscle myosin heavy-chain protein in acute aortic dissection. The smooth muscle myosin heavy chain study". Ann. Intern. Med. 133 (7): 537–41. PMID 11015167.
  74. Marshall LM, Carlson EJ, O'Malley J, Snyder CK, Charbonneau NL, Hayflick SJ, Coselli JS, Lemaire SA, Sakai LY (October 2013). "Thoracic aortic aneurysm frequency and dissection are associated with fibrillin-1 fragment concentrations in circulation". Circ. Res. 113 (10): 1159–68. doi:10.1161/CIRCRESAHA.113.301498. PMID 24036495.
  75. Körner H, Söndenaa K, Söreide JA, Andersen E, Nysted A, Lende TH, Kjellevold KH (1997). "Incidence of acute nonperforated and perforated appendicitis: age-specific and sex-specific analysis". World J Surg. 21 (3): 313–7. PMID 9015177.
  76. Wilms IM, de Hoog DE, de Visser DC, Janzing HM (November 2011). "Appendectomy versus antibiotic treatment for acute appendicitis". Cochrane Database Syst Rev (11): CD008359. doi:10.1002/14651858.CD008359.pub2. PMID 22071846.
  77. Becker T, Kharbanda A, Bachur R (February 2007). "Atypical clinical features of pediatric appendicitis". Acad Emerg Med. 14 (2): 124–9. doi:10.1197/j.aem.2006.08.009. PMID 17192449.
  78. Diehl AK, Sugarek NJ, Todd KH (July 1990). "Clinical evaluation for gallstone disease: usefulness of symptoms and signs in diagnosis". Am. J. Med. 89 (1): 29–33. PMID 2368790.
  79. Fitzgerald JE, White MJ, Lobo DN (April 2009). "Courvoisier's gallbladder: law or sign?". World J Surg. 33 (4): 886–91. doi:10.1007/s00268-008-9908-y. PMID 19190960.
  80. Kreiner M, Okeson JP, Michelis V, Lujambio M, Isberg A (January 2007). "Craniofacial pain as the sole symptom of cardiac ischemia: a prospective multicenter study". J Am Dent Assoc. 138 (1): 74–9. PMID 17197405.
  81. Lee TH, Cook EF, Weisberg M, Sargent RK, Wilson C, Goldman L (January 1985). "Acute chest pain in the emergency room. Identification and examination of low-risk patients". Arch. Intern. Med. 145 (1): 65–9. PMID 3970650.
  82. Foxman B (March 2014). "Urinary tract infection syndromes: occurrence, recurrence, bacteriology, risk factors, and disease burden". Infect. Dis. Clin. North Am. 28 (1): 1–13. doi:10.1016/j.idc.2013.09.003. PMID 24484571.
  83. Hooton TM (March 2012). "Clinical practice. Uncomplicated urinary tract infection". N. Engl. J. Med. 366 (11): 1028–37. doi:10.1056/NEJMcp1104429. PMID 22417256.
  84. Gupta K, Trautner B (March 2012). "In the clinic. Urinary tract infection". Ann. Intern. Med. 156 (5): ITC3–1–ITC3–15, quiz ITC3–16. doi:10.7326/0003-4819-156-5-201203060-01003. PMID 22393148.
  85. Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, Dulgheru R, El Khoury G, Erba PA, Iung B, Miro JM, Mulder BJ, Plonska-Gosciniak E, Price S, Roos-Hesselink J, Snygg-Martin U, Thuny F, Tornos Mas P, Vilacosta I, Zamorano JL (November 2015). "2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM)". Eur. Heart J. 36 (44): 3075–3128. doi:10.1093/eurheartj/ehv319. PMID 26320109.
  86. Meine TJ, Nettles RE, Anderson DJ, Cabell CH, Corey GR, Sexton DJ, Wang A (August 2001). "Cardiac conduction abnormalities in endocarditis defined by the Duke criteria". Am. Heart J. 142 (2): 280–5. doi:10.1067/mhj.2001.116964. PMID 11479467.
  87. Cahill TJ, Prendergast BD (February 2016). "Infective endocarditis". Lancet. 387 (10021): 882–93. doi:10.1016/S0140-6736(15)00067-7. PMID 26341945.
  88. Gumber SC, Chopra S (October 1995). "Hepatitis C: a multifaceted disease. Review of extrahepatic manifestations". Ann. Intern. Med. 123 (8): 615–20. PMID 7677303.
  89. Archard LC, Bowles NE, Behan PO, Bell EJ, Doyle D (June 1988). "Postviral fatigue syndrome: persistence of enterovirus RNA in muscle and elevated creatine kinase". J R Soc Med. 81 (6): 326–9. doi:10.1177/014107688808100608. PMC 1291623. PMID 3404526.
  90. Bratton RL, Whiteside JW, Hovan MJ, Engle RL, Edwards FD (May 2008). "Diagnosis and treatment of Lyme disease". Mayo Clin. Proc. 83 (5): 566–71. doi:10.4065/83.5.566. PMID 18452688.
  91. Fwu CW, Eggers PW, Kimmel PL, Kusek JW, Kirkali Z (March 2013). "Emergency department visits, use of imaging, and drugs for urolithiasis have increased in the United States". Kidney Int. 83 (3): 479–86. doi:10.1038/ki.2012.419. PMC 3587650. PMID 23283137.
  92. Evan AP, Lingeman JE, Coe FL, Parks JH, Bledsoe SB, Shao Y, Sommer AJ, Paterson RF, Kuo RL, Grynpas M (March 2003). "Randall's plaque of patients with nephrolithiasis begins in basement membranes of thin loops of Henle". J. Clin. Invest. 111 (5): 607–16. doi:10.1172/JCI17038. PMC 151900. PMID 12618515.
  93. Kim SC, Coe FL, Tinmouth WW, Kuo RL, Paterson RF, Parks JH, Munch LC, Evan AP, Lingeman JE (January 2005). "Stone formation is proportional to papillary surface coverage by Randall's plaque". J. Urol. 173 (1): 117–9, discussion 119. doi:10.1097/01.ju.0000147270.68481.ce. PMID 15592050.
  94. Swaroop VS, Chari ST, Clain JE (June 2004). "Severe acute pancreatitis". JAMA. 291 (23): 2865–8. doi:10.1001/jama.291.23.2865. PMID 15199038.
  95. Yadav D, Agarwal N, Pitchumoni CS (June 2002). "A critical evaluation of laboratory tests in acute pancreatitis". Am. J. Gastroenterol. 97 (6): 1309–18. doi:10.1111/j.1572-0241.2002.05766.x. PMID 12094843.
  96. Fortson MR, Freedman SN, Webster PD (December 1995). "Clinical assessment of hyperlipidemic pancreatitis". Am. J. Gastroenterol. 90 (12): 2134–9. PMID 8540502.
  97. Brunham RC, Gottlieb SL, Paavonen J (May 2015). "Pelvic inflammatory disease". N. Engl. J. Med. 372 (21): 2039–48. doi:10.1056/NEJMra1411426. PMID 25992748.
  98. Ross J, Judlin P, Jensen J (January 2014). "2012 European guideline for the management of pelvic inflammatory disease". Int J STD AIDS. 25 (1): 1–7. doi:10.1177/0956462413498714. PMID 24216035.
  99. Workowski KA, Bolan GA (June 2015). "Sexually transmitted diseases treatment guidelines, 2015". MMWR Recomm Rep. 64 (RR-03): 1–137. PMID 26042815.
  100. Lassila R, Jula A, Pitkäniemi J, Haukka J (November 2014). "The association of statin use with reduced incidence of venous thromboembolism: a population-based cohort study". BMJ Open. 4 (11): e005862. doi:10.1136/bmjopen-2014-005862. PMC 4225235. PMID 25377011.
  101. Horlander KT, Mannino DM, Leeper KV (July 2003). "Pulmonary embolism mortality in the United States, 1979-1998: an analysis using multiple-cause mortality data". Arch. Intern. Med. 163 (14): 1711–7. doi:10.1001/archinte.163.14.1711. PMID 12885687.
  102. Carson JL, Kelley MA, Duff A, Weg JG, Fulkerson WJ, Palevsky HI, Schwartz JS, Thompson BT, Popovich J, Hobbins TE (May 1992). "The clinical course of pulmonary embolism". N. Engl. J. Med. 326 (19): 1240–5. doi:10.1056/NEJM199205073261902. PMID 1560799.
  103. Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG, Moran GJ, Nicolle LE, Raz R, Schaeffer AJ, Soper DE (March 2011). "International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases". Clin. Infect. Dis. 52 (5): e103–20. doi:10.1093/cid/ciq257. PMID 21292654.
  104. File TM (December 2003). "Community-acquired pneumonia". Lancet. 362 (9400): 1991–2001. doi:10.1016/S0140-6736(03)15021-0. PMID 14683661.
  105. Shah SN, Bachur RG, Simel DL, Neuman MI (August 2017). "Does This Child Have Pneumonia?: The Rational Clinical Examination Systematic Review". JAMA. 318 (5): 462–471. doi:10.1001/jama.2017.9039. PMID 28763554.
  106. Pereira JC, Escuder MM (February 1998). "The importance of clinical symptoms and signs in the diagnosis of community-acquired pneumonia". J. Trop. Pediatr. 44 (1): 18–24. PMID 9538601.
  107. Crum NF (September 2004). "Bacterial pyomyositis in the United States". Am. J. Med. 117 (6): 420–8. doi:10.1016/j.amjmed.2004.03.031. PMID 15380499.
  108. Christin L, Sarosi GA (October 1992). "Pyomyositis in North America: case reports and review". Clin. Infect. Dis. 15 (4): 668–77. PMID 1420680.
  109. Horn CV, Master S (July 1968). "Pyomyositis tropicans in Uganda". East Afr Med J. 45 (7): 463–71. PMID 5722778.
  110. Rodgers WB, Yodlowski ML, Mintzer CM (April 1993). "Pyomyositis in patients who have the human immunodeficiency virus. Case report and review of the literature". J Bone Joint Surg Am. 75 (4): 588–92. PMID 8478386.
  111. Louati K, Berenbaum F (October 2015). "Fatigue in chronic inflammation - a link to pain pathways". Arthritis Res. Ther. 17: 254. doi:10.1186/s13075-015-0784-1. PMC 4593220. PMID 26435495.
  112. Turesson C, O'Fallon WM, Crowson CS, Gabriel SE, Matteson EL (August 2003). "Extra-articular disease manifestations in rheumatoid arthritis: incidence trends and risk factors over 46 years". Ann. Rheum. Dis. 62 (8): 722–7. PMC 1754626. PMID 12860726.
  113. Turesson C, Schaid DJ, Weyand CM, Jacobsson LT, Goronzy JJ, Petersson IF, Dechant SA, Nyähll-Wåhlin BM, Truedsson L, Sturfelt G, Matteson EL (September 2006). "Association of HLA-C3 and smoking with vasculitis in patients with rheumatoid arthritis". Arthritis Rheum. 54 (9): 2776–83. doi:10.1002/art.22057. PMID 16947780.
  114. Dyer DS, Moore EE, Ilke DN, McIntyre RC, Bernstein SM, Durham JD, Mestek MF, Heinig MJ, Russ PD, Symonds DL, Honigman B, Kumpe DA, Roe EJ, Eule J (April 2000). "Thoracic aortic injury: how predictive is mechanism and is chest computed tomography a reliable screening tool? A prospective study of 1,561 patients". J Trauma. 48 (4): 673–82, discussion 682–3. PMID 10780601.
  115. Mirvis SE, Shanmuganathan K, Buell J, Rodriguez A (November 1998). "Use of spiral computed tomography for the assessment of blunt trauma patients with potential aortic injury". J Trauma. 45 (5): 922–30. PMID 9820704.
  116. Migeon CJ, Kenny FM, Hung W, Voorhess ML (August 1967). "Study of adrenal function in children with meningitis". Pediatrics. 40 (2): 163–83. PMID 5006579.
  117. MARGARETTEN W, NAKAI H, LANDING BH (April 1963). "Septicemic adrenal hemorrhage". Am. J. Dis. Child. 105: 346–51. PMID 13932989.
  118. Cotterill SJ, Ahrens S, Paulussen M, Jürgens HF, Voûte PA, Gadner H, Craft AW (September 2000). "Prognostic factors in Ewing's tumor of bone: analysis of 975 patients from the European Intergroup Cooperative Ewing's Sarcoma Study Group". J. Clin. Oncol. 18 (17): 3108–14. doi:10.1200/JCO.2000.18.17.3108. PMID 10963639.
  119. Nesbit ME, Gehan EA, Burgert EO, Vietti TJ, Cangir A, Tefft M, Evans R, Thomas P, Askin FB, Kissane JM (October 1990). "Multimodal therapy for the management of primary, nonmetastatic Ewing's sarcoma of bone: a long-term follow-up of the First Intergroup study". J. Clin. Oncol. 8 (10): 1664–74. doi:10.1200/JCO.1990.8.10.1664. PMID 2213103.
  120. Raney RB, Asmar L, Newton WA, Bagwell C, Breneman JC, Crist W, Gehan EA, Webber B, Wharam M, Wiener ES, Anderson JR, Maurer HM (February 1997). "Ewing's sarcoma of soft tissues in childhood: a report from the Intergroup Rhabdomyosarcoma Study, 1972 to 1991". J. Clin. Oncol. 15 (2): 574–82. doi:10.1200/JCO.1997.15.2.574. PMID 9053479.
  121. Grois N, Pötschger U, Prosch H, Minkov M, Arico M, Braier J, Henter JI, Janka-Schaub G, Ladisch S, Ritter J, Steiner M, Unger E, Gadner H (February 2006). "Risk factors for diabetes insipidus in langerhans cell histiocytosis". Pediatr Blood Cancer. 46 (2): 228–33. doi:10.1002/pbc.20425. PMID 16047354.
  122. Baumgartner I, von Hochstetter A, Baumert B, Luetolf U, Follath F (January 1997). "Langerhans'-cell histiocytosis in adults". Med. Pediatr. Oncol. 28 (1): 9–14. PMID 8950330.
  123. 123.0 123.1 Malpas JS, Norton AJ (December 1996). "Langerhans cell histiocytosis in the adult". Med. Pediatr. Oncol. 27 (6): 540–6. doi:10.1002/(SICI)1096-911X(199612)27:6<540::AID-MPO6>3.0.CO;2-L. PMID 8888814.
  124. Clarke RT, Van den Bruel A, Bankhead C, Mitchell CD, Phillips B, Thompson MJ (October 2016). "Clinical presentation of childhood leukaemia: a systematic review and meta-analysis". Arch. Dis. Child. 101 (10): 894–901. doi:10.1136/archdischild-2016-311251. PMID 27647842.
  125. Konopka JB, Witte ON (November 1985). "Detection of c-abl tyrosine kinase activity in vitro permits direct comparison of normal and altered abl gene products". Mol. Cell. Biol. 5 (11): 3116–23. PMC 369126. PMID 3879812.
  126. Siegel RL, Miller KD, Jemal A (January 2017). "Cancer Statistics, 2017". CA Cancer J Clin. 67 (1): 7–30. doi:10.3322/caac.21387. PMID 28055103.
  127. Faderl S, Talpaz M, Estrov Z, O'Brien S, Kurzrock R, Kantarjian HM (July 1999). "The biology of chronic myeloid leukemia". N. Engl. J. Med. 341 (3): 164–72. doi:10.1056/NEJM199907153410306. PMID 10403855.
  128. Anderson T, Chabner BA, Young RC, Berard CW, Garvin AJ, Simon RM, DeVita VT (December 1982). "Malignant lymphoma. 1. The histology and staging of 473 patients at the National Cancer Institute". Cancer. 50 (12): 2699–707. PMID 7139563.
  129. Mohren M, Markmann I, Jentsch-Ullrich K, Koenigsmann M, Lutze G, Franke A (April 2005). "Increased risk of thromboembolism in patients with malignant lymphoma: a single-centre analysis". Br. J. Cancer. 92 (8): 1349–51. doi:10.1038/sj.bjc.6602504. PMID 15798767.
  130. Cozen W, Katz J, Mack TM (1992). "Risk patterns of Hodgkin's disease in Los Angeles vary by cell type". Cancer Epidemiol. Biomarkers Prev. 1 (4): 261–8. PMID 1303125.
  131. Bazzeh F, Rihani R, Howard S, Sultan I (December 2010). "Comparing adult and pediatric Hodgkin lymphoma in the Surveillance, Epidemiology and End Results Program, 1988-2005: an analysis of 21 734 cases". Leuk. Lymphoma. 51 (12): 2198–207. doi:10.3109/10428194.2010.525724. PMID 21054151.
  132. Banik R, Lubach D (1987). "Skin tags: localization and frequencies according to sex and age". Dermatologica. 174 (4): 180–3. PMID 3582706.
  133. Campbell LB, Petrick MG (March 2007). "Mohs micrographic surgery for a problematic infantile digital fibroma". Dermatol Surg. 33 (3): 385–7. doi:10.1111/j.1524-4725.2007.33080.x. PMID 17338704.
  134. Requena L, Fariña MC, Fuente C, Piqué E, Olivares M, Martín L, Sánchez Yus E (May 1994). "Giant dermatofibroma. A little-known clinical variant of dermatofibroma". J. Am. Acad. Dermatol. 30 (5 Pt 1): 714–8. PMID 8176009.
  135. 135.0 135.1 Copley L, Dormans JP (August 1996). "Benign pediatric bone tumors. Evaluation and treatment". Pediatr. Clin. North Am. 43 (4): 949–66. PMID 8692589.
  136. Greenspan A (October 1993). "Benign bone-forming lesions: osteoma, osteoid osteoma, and osteoblastoma. Clinical, imaging, pathologic, and differential considerations". Skeletal Radiol. 22 (7): 485–500. PMID 8272884.
  137. Boriani S, Capanna R, Donati D, Levine A, Picci P, Savini R (May 1992). "Osteoblastoma of the spine". Clin. Orthop. Relat. Res. (278): 37–45. PMID 1563167.
  138. Orlowski JP, Mercer RD (April 1977). "Osteoid osteoma in children and young adults". Pediatrics. 59 (4): 526–32. PMID 850593.
  139. Wyers MR (April 2010). "Evaluation of pediatric bone lesions". Pediatr Radiol. 40 (4): 468–73. doi:10.1007/s00247-010-1547-4. PMID 20225104.
  140. Mialou V, Philip T, Kalifa C, Perol D, Gentet JC, Marec-Berard P, Pacquement H, Chastagner P, Defaschelles AS, Hartmann O (September 2005). "Metastatic osteosarcoma at diagnosis: prognostic factors and long-term outcome--the French pediatric experience". Cancer. 104 (5): 1100–9. doi:10.1002/cncr.21263. PMID 16015627.
  141. Sissons HA (1976). "The WHO classification of bone tumors". Recent Results Cancer Res. (54): 104–8. PMID 1070715.
  142. CADE S (December 1955). "Osteogenic sarcoma; a study based on 133 patients". J R Coll Surg Edinb. 1 (2): 79–111. PMID 13307660.
  143. Dahlin DC, Unni KK (March 1977). "Osteosarcoma of bone and its important recognizable varieties". Am. J. Surg. Pathol. 1 (1): 61–72. PMID 203202.
  144. Kyle RA, Gertz MA, Witzig TE, Lust JA, Lacy MQ, Dispenzieri A, Fonseca R, Rajkumar SV, Offord JR, Larson DR, Plevak ME, Therneau TM, Greipp PR (January 2003). "Review of 1027 patients with newly diagnosed multiple myeloma". Mayo Clin. Proc. 78 (1): 21–33. doi:10.4065/78.1.21. PMID 12528874.
  145. Turesson I, Velez R, Kristinsson SY, Landgren O (March 2010). "Patterns of multiple myeloma during the past 5 decades: stable incidence rates for all age groups in the population but rapidly changing age distribution in the clinic". Mayo Clin. Proc. 85 (3): 225–30. doi:10.4065/mcp.2009.0426. PMC 2843108. PMID 20194150.
  146. Porta M, Fabregat X, Malats N, Guarner L, Carrato A, de Miguel A, Ruiz L, Jariod M, Costafreda S, Coll S, Alguacil J, Corominas JM, Solà R, Salas A, Real FX (June 2005). "Exocrine pancreatic cancer: symptoms at presentation and their relation to tumour site and stage". Clin Transl Oncol. 7 (5): 189–97. PMID 15960930.
  147. Crawford ED, Schutz MJ, Clejan S, Drago J, Resnick MI, Chodak GW, Gomella LG, Austenfeld M, Stone NN, Miles BJ (1992). "The effect of digital rectal examination on prostate-specific antigen levels". JAMA. 267 (16): 2227–8. PMID 1372943.
  148. Skaggs DL, Early SD, D'Ambra P, Tolo VT, Kay RM (2006). "Back pain and backpacks in school children". J Pediatr Orthop. 26 (3): 358–63. doi:10.1097/01.bpo.0000217723.14631.6e. PMID 16670549.
  149. Combs JA, Caskey PM (August 1997). "Back pain in children and adolescents: a retrospective review of 648 patients". South. Med. J. 90 (8): 789–92. PMID 9258304.
  150. Feldman DS, Hedden DM, Wright JG (2000). "The use of bone scan to investigate back pain in children and adolescents". J Pediatr Orthop. 20 (6): 790–5. PMID 11097256.
  151. Bhatia NN, Chow G, Timon SJ, Watts HG (March 2008). "Diagnostic modalities for the evaluation of pediatric back pain: a prospective study". J Pediatr Orthop. 28 (2): 230–3. doi:10.1097/BPO.0b013e3181651bc8. PMID 18388720.
  152. Paige NM, Miake-Lye IM, Booth MS, Beroes JM, Mardian AS, Dougherty P, Branson R, Tang B, Morton SC, Shekelle PG (April 2017). "Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain: Systematic Review and Meta-analysis". JAMA. 317 (14): 1451–1460. doi:10.1001/jama.2017.3086. PMC 5470352. PMID 28399251.
  153. French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ (January 2006). "Superficial heat or cold for low back pain". Cochrane Database Syst Rev (1): CD004750. doi:10.1002/14651858.CD004750.pub2. PMID 16437495.
  154. Cass SP (January 2015). "Piriformis syndrome: a cause of nondiscogenic sciatica". Curr Sports Med Rep. 14 (1): 41–4. doi:10.1249/JSR.0000000000000110. PMID 25574881.
  155. Natsis K, Totlis T, Konstantinidis GA, Paraskevas G, Piagkou M, Koebke J (April 2014). "Anatomical variations between the sciatic nerve and the piriformis muscle: a contribution to surgical anatomy in piriformis syndrome". Surg Radiol Anat. 36 (3): 273–80. doi:10.1007/s00276-013-1180-7. PMID 23900507.
  156. Prins JB, van der Meer JW, Bleijenberg G (January 2006). "Chronic fatigue syndrome". Lancet. 367 (9507): 346–55. doi:10.1016/S0140-6736(06)68073-2. PMID 16443043.
  157. Katon WJ, Buchwald DS, Simon GE, Russo JE, Mease PJ (1991). "Psychiatric illness in patients with chronic fatigue and those with rheumatoid arthritis". J Gen Intern Med. 6 (4): 277–85. PMID 1890495.
  158. Lane TJ, Manu P, Matthews DA (October 1991). "Depression and somatization in the chronic fatigue syndrome". Am. J. Med. 91 (4): 335–44. PMID 1951377.
  159. Judd LL, Schettler PJ, Coryell W, Akiskal HS, Fiedorowicz JG (November 2013). "Overt irritability/anger in unipolar major depressive episodes: past and current characteristics and implications for long-term course". JAMA Psychiatry. 70 (11): 1171–80. doi:10.1001/jamapsychiatry.2013.1957. PMID 24026579.
  160. 160.0 160.1 van Dessel NC, van der Wouden JC, Dekker J, van der Horst HE (March 2016). "Clinical value of DSM IV and DSM 5 criteria for diagnosing the most prevalent somatoform disorders in patients with medically unexplained physical symptoms (MUPS)". J Psychosom Res. 82: 4–10. doi:10.1016/j.jpsychores.2016.01.004. PMID 26944392.
  161. Ylikorkala O, Dawood MY (April 1978). "New concepts in dysmenorrhea". Am. J. Obstet. Gynecol. 130 (7): 833–47. PMID 25021.
  162. Andersch B, Milsom I (November 1982). "An epidemiologic study of young women with dysmenorrhea". Am. J. Obstet. Gynecol. 144 (6): 655–60. PMID 7137249.
  163. Dworkin RH, Johnson RW, Breuer J, Gnann JW, Levin MJ, Backonja M, Betts RF, Gershon AA, Haanpaa ML, McKendrick MW, Nurmikko TJ, Oaklander AL, Oxman MN, Pavan-Langston D, Petersen KL, Rowbotham MC, Schmader KE, Stacey BR, Tyring SK, van Wijck AJ, Wallace MS, Wassilew SW, Whitley RJ (January 2007). "Recommendations for the management of herpes zoster". Clin. Infect. Dis. 44 Suppl 1: S1–26. doi:10.1086/510206. PMID 17143845.
  164. Jumaan AO, Yu O, Jackson LA, Bohlke K, Galil K, Seward JF (June 2005). "Incidence of herpes zoster, before and after varicella-vaccination-associated decreases in the incidence of varicella, 1992-2002". J. Infect. Dis. 191 (12): 2002–7. doi:10.1086/430325. PMID 15897984.
  165. Kost RG, Straus SE (July 1996). "Postherpetic neuralgia--pathogenesis, treatment, and prevention". N. Engl. J. Med. 335 (1): 32–42. doi:10.1056/NEJM199607043350107. PMID 8637540.
  166. Foti T, Davids JR, Bagley A (May 2000). "A biomechanical analysis of gait during pregnancy". J Bone Joint Surg Am. 82 (5): 625–32. PMID 10819273.
  167. Bliddal M, Pottegård A, Kirkegaard H, Olsen J, Jørgensen JS, Sørensen TI, Dreyer L, Nohr EA (May 2016). "Association of Pre-Pregnancy Body Mass Index, Pregnancy-Related Weight Changes, and Parity With the Risk of Developing Degenerative Musculoskeletal Conditions". Arthritis Rheumatol. 68 (5): 1156–64. doi:10.1002/art.39565. PMID 26714126.
  168. MacEvilly M, Buggy D (March 1996). "Back pain and pregnancy: a review". Pain. 64 (3): 405–14. PMID 8783303.
  169. Sanderson PL, Fraser RD (November 1996). "The influence of pregnancy on the development of degenerative spondylolisthesis". J Bone Joint Surg Br. 78 (6): 951–4. PMID 8951013.
  170. Weinreb JC, Wolbarsht LB, Cohen JM, Brown CE, Maravilla KR (January 1989). "Prevalence of lumbosacral intervertebral disk abnormalities on MR images in pregnant and asymptomatic nonpregnant women". Radiology. 170 (1 Pt 1): 125–8. doi:10.1148/radiology.170.1.2521192. PMID 2521192.
  171. Platt OS, Thorington BD, Brambilla DJ, Milner PF, Rosse WF, Vichinsky E, Kinney TR (July 1991). "Pain in sickle cell disease. Rates and risk factors". N. Engl. J. Med. 325 (1): 11–6. doi:10.1056/NEJM199107043250103. PMID 1710777.
  172. Keeley K, Buchanan GR (August 1982). "Acute infarction of long bones in children with sickle cell anemia". J. Pediatr. 101 (2): 170–5. PMID 7097407.
  173. Resar LM, Oliva MM, Casella JF (November 1996). "Skull infarction and epidural hematomas in a patient with sickle cell anemia". J. Pediatr. Hematol. Oncol. 18 (4): 413–5. PMID 8888755.
  174. Milhorat TH (March 2000). "Classification of syringomyelia". Neurosurg Focus. 8 (3): E1. doi:10.3171/foc.2000.8.3.1. PMID 16676921.
  175. Brickell KL, Anderson NE, Charleston AJ, Hope JK, Bok AP, Barber PA (August 2006). "Ethnic differences in syringomyelia in New Zealand". J. Neurol. Neurosurg. Psychiatry. 77 (8): 989–91. doi:10.1136/jnnp.2005.081240. PMC 2077633. PMID 16549414.
  176. Larner AJ, Muqit MM, Glickman S (January 2002). "Concurrent syrinx and inflammatory central nervous system disease detected by magnetic resonance imaging: an illustrative case and review of the literature". Medicine (Baltimore). 81 (1): 41–50. PMID 11807404.
  177. Inaba K, DuBose JJ, Barmparas G, Barbarino R, Reddy S, Talving P, Lam L, Demetriades D (January 2011). "Clinical examination is insufficient to rule out thoracolumbar spine injuries". J Trauma. 70 (1): 174–9. doi:10.1097/TA.0b013e3181d3cc6e. PMID 20489662.
  178. Klahr S (February 1983). "Pathophysiology of obstructive nephropathy". Kidney Int. 23 (2): 414–26. PMID 6842965.
  179. McAleer IM, Kaplan GW, LoSasso BE (October 2002). "Congenital urinary tract anomalies in pediatric renal trauma patients". J. Urol. volume=168 (4 Pt 2): 1808–10, discussion 1810. doi:10.1097/01.ju.0000028338.48621.57. PMID 12352365.
  180. Tekin A, Tekgul S, Atsu N, Ergen A, Kendi S (March 2001). "Ureteropelvic junction obstruction and coexisting renal calculi in children: role of metabolic abnormalities". Urology. 57 (3): 542–5, discussion 545–6. PMID 11248635.


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